Give BIG Day Employee Giving Payroll Deduction Form

Thank you for generously supporting Give BIG Day! We are incredibly grateful for members of the Baylor family like you who go above and beyond to help us continue to make discoveries, advance treatments, educate tomorrow’s physicians and extend care to all.

Please complete this form to set up your recurring payroll deduction gift. Once you submit, you will receive confirmation of your submission, followed by an official gift acknowledgement through the mail within two weeks.

Contact Information

CONTACT INFORMATION

Name:

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Address:

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Street 2:

City/Town:

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State / Province:

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ZIP / Postal Code:

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Email:

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If you respond and have not already registered, you will receive periodic updates and communications from Baylor College of Medicine.

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Gift Information

Field Is Required How much would you like to give in total for Give BIG Day? (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Amount to deduct per paycheck (A minimum of $5 is required):

I would like my payroll deduction to start after this date (leave blank if you'd like to start immediately). Note: It may take up to two pay periods for your deduction to begin):

Field Is Required My gift should be designated to support the following area: (Select one of the available choices or enter a different value.)

My gift should be designated to support the following area: Click this to indicate that you will select an existing value. Tab to next input." My gift should be designated to support the following area: Please select response College Priorities Fund Patient Care Fund Research Fund Education Fund Community Service Fund The GRAB (Grocery Resource at Baylor) Student Scholarship Fund Employee Emergency Relief Fund My gift should be designated to support the following area: Click this to indicate that you will enter a new value. Tab to next input." My gift should be designated to support the following area: Provide your answer here

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